Aetna Encounter Validation Analyst in Phoenix, Arizona

Req ID: 52996BR


This position supports the Medicaid Encounter processes including new plan implementations, system upgrades, and regulatory changes by plan. The Analyst is responsible for defining the reporting requirements based on each state specifics and working with Data Base Analysts to ensure the report requirements are met. Proactively defines, identifies, develops and implements information products to support business strategic and operational planning. Assists in the development of and participates in the presentation to existing and prospective customers and internal business areas. Creates and executes deliverables as part of a team assigned to a business.

Fundamental Components:

Candidate is responsible for the creation and submission of encounter data to State and federal entities in accordance with regulatory and contractual requirements for accuracy and timeliness. Resolves problems in a timely and effective manner. Uses designated systems to obtain information. Analyzes and verifies system results to ensure accuracy, accountability and financial data integrity. Possesses working knowledge of functions of other units in department. Responds to and resolves customer inquiries and complaints (internal as well as external), both verbal and written correspondence within established unit time frames. Analyzes and resolves system error conditions within established unit time frames. Participates as a member of a project team.

  • Analyzes and recommends solutions to nonstandard requests and requirements from plan sponsors and areas within and outside the area

  • Processes customer new business and other transactions and records in appropriate systems

  • Uses system produced data to prepare management level reports

  • Oversight for reporting on 2-3 Medicaid plans

  • Monitor, review, research, reconcile and balance designated Aetna system activity


Strong 837 experience required

Familiarity with SQL along with other HIPAA transactions and code sets

Knowledge of all types of managed care products including HMO, PPO, and Medicare Part C

Background in claims, root cause analysis and / or health care data

Strong critical thinking skills

Strong analytical skills

Strong organizational skills including the ability to manage tasks with competing priorities

Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook) and Internet Explorer.

Excellent verbal and written communication skills.


The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.


Functional - Information Management/Data acquisition, data management, programming and documentation/4-6 Years

Functional - Information Management/Query and Database Access Tools/1-3 Years

Functional - Information Technology/Computer operations/1-3 Years

Functional - Information Technology/Research/4-6 Years

Functional - Claims/Reporting & special services/4-6 Years


Technical - Database/SQL Server/1-3 Years/End User

TechnicalExperience/TechnicalFocus/4-6 Years/Power User

Technical - Aetna Applications/Aetna Encounter Processing System/4-6 Years/Power User

Technical - EDI/EDI/4-6 Years/End User


General Business/Communicating for Impact/FOUNDATION

General Business/Turning Data into Information/ADVANCED

Technology/Selecting and Applying Technology Solutions/FOUNDATION


General Business/Maximizing Work Practices/ADVANCED

Leadership/Driving a Culture of Compliance/FOUNDATION

Technology/Leveraging Technology/ADVANCED

Telework Specifications:

Considered only for current internal teleworkers


Fast paced, technical and highly regulated area.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care